Personal Data

Last Name:

First Name:

Middle:

Social Security #:

Date of Birth:

Street Address:

Apt/Suite #:

City:

State:

Zip Code:

Home Telephone:

Work Telephone:

Cellular Phone:

E-Mail:

Educational Data**

High School:

Degree/Credits:

GPA:

Year:

College:

Degree/Credits:

GPA:

Year:

Employment Data**

Employer:

Position:

Dates (from/to):

Employer:

Position:

Dates (from/to):

Are you currently or have you ever been, charged with or subject to disciplinary action for scholastic (such as plagiarism or cheating) or any other type of behavioral misconduct at any educational institution? You do not need to disclose academic dismissal, suspension, or probation for poor grades.

Have you ever been charged with a violation of the law, misdemeanor and/or felony (even if adjudication was withheld) which resulted in, or, if still pending could result in, probation, community service, restitution, a jail sentence or the revocation or suspension of your driver’s license (you are not required to include traffic violations which only resulted in a fine)?

When do you plan to begin the Paralegal Certificate Program?

Do you plan to go full-time (3 nights a week)?

Do you plan to get your Certificate of Completion from us?

How did you hear about the program?

I understand that this application is for admission only to the PARALEGAL CERTIFICATE PROGRAM and all information contained herein will be held in confidence as provided by law.

I certify that the information given in this application is complete and accurate and, if admitted, I hereby agree to abide by the policies of the Advisory Board of the PARALEGAL CERTIFICATE PROGRAM and the rules and regulations governing said Program and Florida Atlantic University.